I decided to write on this topic because I see so many mothers struggle to feed their baby and they feel like a failure if they don't exclusively breastfeed. And then to top it off I saw a blog that encouraged exclusive breastfeeding without any foods or supplements until one year of age. I knew someone had to counter that thought before it becomes popular. It shouldn't be a badge of honor to breastfeed to the point of potential harm to the infant, and some ultra-crunchy moms are bragging about it as if it is.
You're not a failure if you feed your baby, regardless of what you feed your baby as long as it's age appropriate. Your baby needs nutrition and hydration. While most babies under 6 months of age can get all their nutrition from breastmilk, some need a boost, especially at the beginning of life. If you’re not producing enough milk, you’ll need to give your baby some formula as well (or use a milk donor). Usually this is temporary - just until your own milk supply increases or until your baby starts enough solid foods that the supplement isn’t needed. I'm not suggesting that every newborn who struggles at the breast should be supplemented, but if your doctor says the baby's blood sugar is low or the baby is losing too much weight, it's not only okay, but it's necessary to supplement.
Benefits of Breast Milk
Most of us have heard by now the many benefits of breastfeeding for the baby, including:
- Immune system benefits. (Which means fewer infections, meaning not only helping babies stay healthy, but also leading to fewer lost work days for working parents and fewer sleepless nights for all parents.)
- Decreased risk of Sudden Infant Death Syndrome.
- Decreased risk of asthma in a child who has breastfed.
- Decreased risk of diabetes when the baby grows up.
- Decreased risk of obesity as the baby grows up.
- Decreased risk of certain cancers in the child, such as leukemia.
- Improved cognitive development of the child.
- Less bleeding, both in the immediate postpartum period from contracting the uterus after birth, and fewer menstrual cycles during breastfeeding.
- Decreased risk of getting pregnant while breastfeeding - though this is not 100% effective! If you're not wanting to get pregnant don't rely on breastfeeding alone.
- Easier return to pre-pregnancy weight.
- Decreased risk of ovarian and breast cancers.
- Decreased risk of Type II diabetes.
- Decreased risk of postpartum depression.
- Decreased risk of heart disease.
- Less missed work (see immune system benefits above).
- Cost - breastmilk is free and formula is expensive. Breast pumps should be covered by insurance.
When Breast Milk Isn't Enough, Isn't Desired, or Isn't Safe
Despite the benefits, breastfeeding not always possible or desired. In the US, 8 out of 10 mothers start breastfeeding during the newborn period. Only half are still nursing at 6 months, and less than a third are still nursing at 12 months.
The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months, followed by continued breastfeeding for 1 year or longer, as mutually desired by mother and child. Some AAP sources indicate starting foods at 4-6 months. The American Academy of Allergy, Asthma & Immunology (AAAAI) recommends introducing foods between 4 and 6 months to prevent certain allergies.
There are very few contraindications to breastfeeding:
- Classic galactosemia. Classic galactosemia is a rare genetic condition in which a baby is unable to metabolize galactose. It is one of the conditions we screen on the newborn screen. Galactose is the sugar made from the lactose in milk. When galactose is not metabolized, it will reach high levels in the blood and become toxic, causing cataracts in the eyes, damage to the liver and kidneys, and brain damage. The galactosemic baby will fail to thrive on breast milk or formula based on cow's milk. The treatment for this condition is to remove all sources of lactose from the baby's diet and give soy formula.
- HIV. Mothers who have HIV and are able to feed formula made with safe water should not breastfeed according to current guidelines. However, there is growing evidence that HIV positive mothers who take proper medications can safely breastfeed.
- Untreated active tuberculosis.
- Chemotherapy or radiation treatment.
- Certain drugs. Most medications are compatible with breastfeeding. You can look on Lactmed to learn if a particular medicine is safe or what other options are recommended.
Some mothers do not want to breastfeed for various reasons. That's okay. It isn't for everyone. No one should say things that make these mothers feel guilty. They brought new life into the world. That alone is an amazing feat. As long as the baby is fed age-appropriate and formula that has been approved for use in infants, it is great.
Babies can thrive on formula. Just be careful of the many alternate formulas and milks that are advertised online. Discuss with your child's pediatrician if you plan on making your own formula or giving another alternative milk. There are many concerns with these, as discussed in Please Don’t Feed Your Baby Homemade Formula!
Some mothers really want to exclusively breastfeed but they have problems. Working with a lactation consultant and physicians (both mother's and baby's doctors) might help if there is a correctable condition, such as
- insufficient breastfeeding attempts per 24 hours - not feeding frequently decreases supply
- tongue tie treatment can improve latch and milk transfer from the breast into baby
- jaundice, which makes baby sleepy and not feed as effectively
- identifying and treating hormonal problems in mother
- identifying and stopping medicines or herbs that might be inhibiting milk supply
- stopping nipple shields as soon as possible - the use of nipple shields can decrease breast stimulation and lower supply
- avoid unnecessary supplements - supplementing with formula can decrease supply overall because the mother's breast makes milk based on how much is used (This does not mean you should avoid formula if it is medically necessary.)
Even when breastfeeding goes well for both Mother and Baby, it is not sufficient to be the sole source of nutrition for the entire first year of life. There are some mom blogs that support exclusive breastfeeding for the first year of life, and that is not safe. I'm not linking any of them here because I don't want to promote them, but if you don't believe me just do a quick search and you will find some.
While breast milk is fantastic for young infants, it does not have the nutritional components to exclusively feed for the second half of the first year. Feeding with food from fingers or a spoon also encourages healthy development of fine motor skills.
Any problems feeding should be discussed with your child's doctor
Vitamin D & Iron Supplements for Babies: AAP Recommendations
Related Blogs on Quest for Health
Breastfeeding: Easier for Working Moms with New Insurance Rules